<wicket:panel>
	<br />
	<br />
	<div class="well">
		<form id="tab" class="form-horizontal" wicket:id="userForm">
			<fieldset>
				<div class="span4 smvlabel">
					<!-- Text input-->
					<div class="control-group">
						<label class="control-label" for="fName">First Name</label>
						<div class="controls">
							<input id="fName" name="fName" type="text"
								placeholder="First Name" class="input-xlarge" required=""
								wicket:id="firstName">
						</div>
					</div>
					<div class="control-group">
						<label class="control-label" for="lName">Last Name</label>
						<div class="controls">
							<input id="lName" name="lName" type="text"
								placeholder="Last Name" class="input-xlarge" required=""
								wicket:id="lastName">
						</div>
					</div>

					<!-- Text input-->
					<div class="control-group">
						<label class="control-label" for="Address1">Address Line1</label>
						<div class="controls">
							<input id="Address" name="Address1" type="text"
								placeholder="Address Line1" class="input-xlarge"
								wicket:id="line1">
						</div>
					</div>
					<div class="control-group">
						<label class="control-label" for="Address2">Address Line2</label>
						<div class="controls">
							<input id="Address" name="Address2" type="text"
								placeholder="Address Line2" class="input-xlarge"
								wicket:id="line2">
						</div>
					</div>
					<div class="control-group">
						<label class="control-label" for="City">City</label>
						<div class="controls">
							<input id="City" name="City" type="text" placeholder="City"
								class="input-xlarge" wicket:id="city">
						</div>
					</div>
					<div class="control-group">
						<label class="control-label" for="State">State</label>
						<div class="controls">
							<input id="State" name="State" type="text" placeholder="State"
								class="input-xlarge" wicket:id="state">
						</div>
					</div>

					<!-- Text input-->
					<div class="control-group">
						<label class="control-label" for="mobile">Mobile</label>
						<div class="controls">
							<input id="mobile" name="mobile" type="text" placeholder="Mobile"
								class="input-xlarge" wicket:id="mobileNo">
						</div>
					</div>

					<!-- Text input-->
					<div class="control-group">
						<label class="control-label" for="selectbasic">Company</label>
						<div class="controls">
							<select id="select1" name="selectbasic" class="input-large"
								wicket:id="company">
								<option>New</option>
								<option>Infy</option>
								<option>Wells Fargo</option>
							</select>
						</div>
					</div>

					<!-- Text input-->
					<div class="control-group">
						<label class="control-label" for="locality">Locality</label>
						<div class="controls">
							<input id="locality" name="locality" type="text"
								placeholder="Locality" class="input-xlarge" wicket:id="locality">
						</div>
					</div>
					
				</div>
				<div class="span4 offset1 smvlabel">
				<!-- Select Multiple -->
					<div class="control-group">
						<label class="control-label" for="mycircle">My Circles</label>
						<div class="controls">
							<select id="mycircle" name="mycircle" class="input-xlarge"
								multiple="multiple" wicket:id="circles">
								<option>Adobe</option>
								<option>Bridge millenium</option>
								<option>Project X</option>
								<option>Tech span</option>
							</select>
						</div>
					</div>
					<!-- Text input-->
					<div class="control-group">
						<label class="control-label" for="age">Age</label>
						<div class="controls">
							<input id="age" name="age" type="text" placeholder="Age"
								class="input-xlarge" wicket:id="age">
						</div>
					</div>

					<!-- Multiple Radios (inline) -->
					<div class="control-group">
						<label class="control-label" for="sex">Sex</label>
						<div class="controls">
							<span wicket:id="gender" id="radio"></span>
						</div>
					</div>

					<!-- Text input-->
					<div class="control-group">
						<label class="control-label" for="email">Login Email</label>
						<div class="controls">
							<input id="email" name="email" type="text"
								placeholder="Login Email" class="input-xlarge" required=""
								wicket:id="emailId">
						</div>
					</div>

					<!-- Password input-->
					<div class="control-group">
						<label class="control-label" for="password">Password</label>
						<div class="controls">
							<input id="password" name="password" type="password"
								placeholder="Password" class="input-xlarge" required=""
								wicket:id="password">
						</div>
					</div>

					<!-- Password input-->
					<div class="control-group">
						<label class="control-label" for="re password">Retype
							Password</label>
						<div class="controls">
							<input id="re password" name="re password" type="password"
								placeholder="Retype Password" class="input-xlarge" required=""
								wicket:id="confirm">
						</div>
					</div>

					<!-- Select Multiple -->
					<div class="control-group">
						<label class="control-label" for="travel">Travel</label>
						<div class="controls">
							<select id="travel" name="travel" class="input-xlarge"
								multiple="multiple" wicket:id="travels">
								<option>Consumer</option>
								<option>Provider</option>
								<option>Both</option>
								<option>Taxi</option>
							</select>
						</div>
					</div>

					<!-- Select Basic -->

					<!-- add more -->
					<!-- <div class="control-group">
						<label class="control-label" for="textinput"></label>
						<div class="controls">
							<a href="#">Add Vehicle</a>

						</div>
					</div> -->

					<div class="control-group">
						<div class="controls">
							<button type="submit" class="btn btn-primary "
								wicket:id="register">Register</button>
							<button type="reset" class="btn ">Reset</button>
						</div>
					</div>
				</div>
			</fieldset>
		</form>
		<span wicket:id="newCompany"></span>
	</div>
</wicket:panel>